{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:13:36Z","timestamp":1787015616981,"version":"build-2736575974"},"reference-count":51,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Metabolic dysfunction\u2010associated steatotic liver disease (MASLD) poses a significant health burden and impacts quality of life (QoL). This study evaluates the effects of essential phospholipids (EPL) on liver steatosis, QoL, and other liver and metabolic parameters in patients with MASLD and associated comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this multicenter, double\u2010blind, randomised, placebo\u2010controlled phase 4 clinical trial, patients with MASLD and type 2 diabetes, hyperlipidemia, or obesity received either EPL or placebo, alongside standard of care. Primary endpoint: change in hepatic steatosis from baseline to 6\u2009months (measured by Controlled Attenuation Parameter [CAP] score); secondary endpoints: changes in QoL (measured by the Chronic Liver Disease Questionnaire [CLDQ\u2010MASLD]), symptom changes; other endpoints: other liver, metabolic, and lipid parameters, and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 193 randomised patients, 165 constituted the modified intention\u2010to\u2010treat population (median age: 56.5\u2009years [EPL arm], 55.0\u2009years [placebo arm]). More than \u00be of patients were obese and had CAP score \u2265\u2009280\u2009dB\/m. At 6\u2009months, EPL treatment significantly reduced CAP (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0269) versus placebo. This effect was evident at 3\u2009months (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0049) and sustained until 3\u2009months post treatment (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0234). QoL total score showed numerical improvement, with statistically significant improvement in fatigue subscore (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0229) with EPL versus placebo at 6\u2009months. EPL significantly improved HbA1c levels (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0069) over 6\u2009months. No safety concerns arose.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The beneficial effects of EPL on hepatic steatosis, QoL and glycemic control, and its favourable safety profile make it a promising candidate for managing steatosis and enhancing overall liver health in MASLD patients with cardiometabolic risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>The trial was registered in the EudraCT (2021\u2010006069\u201039)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70601","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T05:33:43Z","timestamp":1774589623000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Effect of Essential Phospholipids in Metabolic Dysfunction\u2010Associated Steatotic Liver Disease: A Randomised Phase 4 Clinical Trial"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2186-9595","authenticated-orcid":false,"given":"Norbert","family":"Stefan","sequence":"first","affiliation":[{"name":"Department of Internal Medicine IV University Hospital T\u00fcbingen  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Hartleb","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Medical University of Silesia  Katowice Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangao","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Xinhua Hospital Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00fcnevver","family":"Demir","sequence":"additional","affiliation":[{"name":"Department of Hepatology and Gastroenterology, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Campus Virchow\u2010Klinikum and Campus Charit\u00e9 Mitte  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4224-4703","authenticated-orcid":false,"given":"J\u00f6rn M.","family":"Schattenberg","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II Saarland University Medical Center  Homburg Germany"},{"name":"PharmaScienceHub (PSH) Saarland University  Saarbr\u00fccken Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Gietka","sequence":"additional","affiliation":[{"name":"Hepatolodzy Outpatient Clinic  Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0141ukasz","family":"Bu\u0142dak","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Pharmacology Medical University of Silesia  Katowice Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branko","family":"Popovic","sequence":"additional","affiliation":[{"name":"Opella Healthcare A. 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